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Dissociative Identity Disorder in an Adolescent With Nine Alternate Personality Traits: A Case Study. 九种人格特质的青少年解离性身份障碍个案研究。
IF 2 Q2 Medicine Pub Date : 2022-07-01 DOI: 10.5765/jkacap.220005
Sang-Hun Lee, Na Ri Kang, Duk-Soo Moon

Since dissociative identity disorder (DID) has symptoms similar to schizophrenia, such as auditory hallucinations and delusional thoughts of being controlled, there are difficulties in its differential diagnosis. A 16-year-old adolescent male patient who was previously diagnosed with schizophrenia from a different hospital was admitted to our inpatient psychiatric unit for the evaluation of auditory hallucinations and suicide attempts. Through psychiatric evaluations, it was determined that the patient suffered from identity alternation, dissociation, and amnesia. As for the diagnostic evaluations, the following measures were implemented: a psychiatric interview regarding the diagnostic criteria, mental status examination, laboratory tests, brain imaging studies, electroencephalography, and full psychological test for adolescents, and the self-reported measure of the Adolescent Dissociative Experiences Scale. The patient was diagnosed with DID, and the following treatments were administered: pharmacotherapy, ego state therapy, psychoeducation regarding emotions, trauma-focused psychotherapy including stabilization, and family therapy. Following treatment, in the internal dimensions, the patient was able to recognize the nine alternate identities in charge of his emotions, which established a basis for the potential integration of identities. In the external dimensions, he showed improvements in the aspects of family conflicts and issue of school refusal. This is the first reported case of DID in an adolescent in Korea; it emphasizes the consideration of DID in the differential diagnosis of other mental illnesses such as schizophrenia, bipolar disorder, and posttraumatic stress disorder and expands the treatment opportunities for DID by sharing the procedures of ego state therapy.

由于分离性身份障碍(DID)具有与精神分裂症相似的症状,如幻听和被控制的妄想,因此其鉴别诊断存在困难。一名16岁的青少年男性患者曾在其他医院被诊断患有精神分裂症,他被送入我们的住院精神科,以评估幻听和自杀企图。通过精神病学评估,确定患者患有身份交替,分离和健忘症。在诊断评估方面,实施了以下措施:关于诊断标准的精神病学访谈,精神状态检查,实验室测试,脑成像研究,脑电图,青少年全面心理测试,以及青少年分离体验量表的自我报告测量。患者被诊断为DID,并给予以下治疗:药物治疗、自我状态治疗、情绪心理教育、创伤心理治疗(包括稳定治疗)和家庭治疗。经过治疗后,在内部维度上,患者能够识别控制其情绪的九个不同身份,这为身份的潜在整合奠定了基础。在外部维度上,他在家庭冲突和拒学问题方面有所改善。这是韩国首次报道的青少年DID病例;它强调在其他精神疾病如精神分裂症、双相情感障碍和创伤后应激障碍的鉴别诊断中考虑DID,并通过分享自我状态治疗的过程来扩大DID的治疗机会。
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引用次数: 1
Adolescents in Society. 社会中的青少年。
IF 2 Q2 Medicine Pub Date : 2022-07-01 DOI: 10.5765/jkacap.220017
Adolescents form an ever-changing culture as they actively interact with their surrounding environment, and each phenomenon has received clinical attention during the previous eras. For example, the use of inhalants by adolescents in underserved areas, problematic internet use, school violence, and non-suicidal self-injury (NSSI) have reflected or appeared to parallel social changes. Problematic internet use, “game addiction” in a narrower sense, gained worldwide recognition when high-speed internet became widely accessible, and the game industry showed unprecedented growth in the market. As a novel phenomenon at the time, many mental health professionals had to develop hypotheses to understand its nature. Initially, it was viewed as the equivalent of substance dependence in terms of the brain’s reward pathway to interpersonal psychology, seeing the internet as an extension of a parent-child relationship and as a remedy for social anxiety arising from frustration in relationships [1]. Nevertheless, one of the most straightforward explanations is the relationship with other mental health conditions, such as attention deficit hyperactivity disorder, depressive disorder, obsessive-compulsive disorder, and anxiety disorder, reflecting common underlying psychopathology or vulnerability to behavioral addiction [2]. Through this process, our society has been molded by various perspectives, from blaming the gaming industry to forming policies to limit the amount of time adolescents spend on internet games. Today, in the perspective of mental health conditions, excessive internet use has secured a temporary position in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [3] research criteria, patiently awaiting further investigation of its essence as an independent disorder. School violence, especially social rejection and victimization at school, passed similar pathways. While school violence has always existed, it was not until the recent tragic stories of the victims that it began to receive clinical and social attention. Similar to the internet gaming disorder, diverse aspects of school bullying have caused concerns, including influences of changes in the social hierarchy, educational system, and moral issues, as well as comorbid internalizing and externalizing behaviors in both the bullies and the victims. Based on the accumulated research findings, school violence is like a zig-saw puzzle that cannot be defined as a single phenomenon but involves a little bit of everything. The solutions suggested have been multi-dimensional, ranging from universal, holistic intervention in the school environment to educating bystanders and establishing a legal system for perpetrators to receive active interventions targeting comorbid psychiatric conditions in both parties. While these approaches alone will not eradicate the violent behaviors inside school settings, efforts from multiple parties have made our society more vigilant about it. Recen
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引用次数: 0
Clinical Characteristics of Adolescents Hospitalized Through Emergency Room for Intentional Self-Harm or Suicide Attempts. 青少年故意自残或自杀未遂的临床特征
IF 2 Q2 Medicine Pub Date : 2022-07-01 DOI: 10.5765/jkacap.220002
Tae Yeon Yoon, Hyun Sook Lee, Jung-Woo Son, Sang Mi Kim, Je Jung Lee

Objectives: This study aimed to investigate the clinical characteristics of adolescents hospitalized through the emergency room for intentional self-harm or suicide attempts.

Methods: This retrospective study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted between 2006 and 2018 for individuals aged 10-24 years. The clinical characteristics of the patients were analyzed and compared across sex and age groups using the Rao-Scott chi-square tests and multiple logistic regression analysis for complex survey data.

Results: The most common psychiatric diagnosis was mood disorder (22.0%), and more female patients were diagnosed with it than male patients (p=0.010). The 19-24 years age group was diagnosed with mood disorder the most compared to other younger groups (p=0.012). Male patients used lethal methods more than female patients (p=0.008), and the 19-24 years age group used more drug poisoning and cutting or piercing (p<0.001) for intentional self-harm or suicide attempts than younger groups.

Conclusion: Adolescents hospitalized for intentional self-harm or suicide attempts showed significant differences in clinical characteristics across sex and age groups. These findings suggest that measures for preventing self-harm or suicide attempts need to be differentiated according to the sex and age of adolescents.

目的:本研究旨在探讨因故意自残或自杀未遂而进入急诊室的青少年的临床特征。方法:本回顾性研究使用了2006年至2018年对10-24岁个体进行的韩国国立医院出院深度损伤调查的数据。采用Rao-Scott卡方检验和对复杂调查数据的多元logistic回归分析,对不同性别和年龄组患者的临床特征进行分析和比较。结果:精神科诊断以情绪障碍最为常见(22.0%),女性患者多于男性患者(p=0.010)。与其他年轻群体相比,19-24岁年龄组被诊断为情绪障碍最多(p=0.012)。男性患者使用致死方法多于女性患者(p=0.008), 19-24岁年龄组使用药物中毒和割伤或穿刺的方法较多(结论:因故意自残或自杀未遂住院的青少年的临床特征在性别和年龄组之间存在显著差异。这些发现表明,预防自残或自杀企图的措施需要根据青少年的性别和年龄进行区分。
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引用次数: 0
Preliminary Validation Study of the Korean Version of the DSM-5 Level 2 Cross-Cutting Symptom Measure: Depression and Irritability for Parents of Children Aged 6-17 Years. 韩国版DSM-5第二级交叉症状测量:6-17岁儿童父母抑郁与易怒的初步验证研究
IF 2 Q2 Medicine Pub Date : 2022-07-01 DOI: 10.5765/jkacap.220009
Min-Sup Shin, Bung-Nyun Kim, Mirae Jang, Hanbyul Shin, Gyujin Seo

Objectives: This study investigated the reliability and validity of the Korean version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 2 Cross-Cutting Symptom Measure-Patient-Reported Outcomes Measurement Information System (PROMIS)-Depression and the Irritability for parents of children aged 6-17 years.

Methods: Participants were 190 children diagnosed with depressive disorder (n=14), anxiety disorder (n=21), attention-deficit/hyperactivity disorder (ADHD; n=111), ADHD with anxious depression (n=13), and tic disorder with somatic symptoms (n=31). Patients were 8-15 years of age. The participants' mothers completed the Korean versions of the DSM-5 Level 2 Cross-Cutting Symptom Measure- PROMIS Depression and Irritability (Affective Reactivity Index, ARI), and the Korean Child Behavior Checklist (K-CBCL). Using these data, we calculated the reliability coefficient and examined the concurrent and discriminant validity of the PROMIS Depression and the Irritability (ARI) scales for assessing depression and irritability in children.

Results: The reliability coefficient of the PROMIS Depression scale (Cronbach's α) was 0.93. The correlation coefficient with the KCBCL DSM emotional problem score was 0.71. The PROMIS Depression scale significantly discriminated children with depressive disorders from those with other conditions. The reliability coefficient of the Irritability (ARI) scale was 0.91, suggesting its high reliability.

Conclusion: Our results suggest that the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure for Depression and Irritability Scales for parents of children aged 6-17 years is reliable and valid and may be an efficient alternative to the K-CBCL.

目的:本研究探讨韩文版《精神障碍诊断与统计手册》第五版(DSM-5)第二级交叉症状测量-患者报告结果测量信息系统(PROMIS)- 6-17岁儿童父母抑郁与易怒的信度和效度。方法:参与者为190名被诊断为抑郁症(n=14)、焦虑症(n=21)、注意缺陷/多动障碍(ADHD;n=111), ADHD伴焦虑抑郁(n=13),抽动障碍伴躯体症状(n=31)。患者年龄8 ~ 15岁。参与者的母亲完成了韩国版DSM-5第2级交叉症状测量- PROMIS抑郁和易怒(情感反应指数,ARI)和韩国儿童行为检查表(K-CBCL)。利用这些数据,我们计算了信度系数,并检验了PROMIS抑郁和易怒(ARI)量表用于评估儿童抑郁和易怒的并发效度和判别效度。结果:PROMIS抑郁量表的信度系数(Cronbach’s α)为0.93。与KCBCL DSM情绪问题得分的相关系数为0.71。PROMIS抑郁量表显著区分抑郁障碍儿童和其他疾病儿童。易怒(ARI)量表的信度系数为0.91,具有较高的信度。结论:我们的研究结果表明,韩国版DSM-5 6-17岁儿童父母抑郁和易怒症状交叉测量量表是可靠和有效的,可能是K-CBCL的有效替代。
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引用次数: 0
Stimulant Induced Movement Disorders in Attention Deficit Hyperactivity Disorder 注意缺陷多动障碍中兴奋剂引起的运动障碍
IF 2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5765/jkacap.210034
S. Nam, M. Lim, T. Park
Stimulants, such as amphetamine and methylphenidate, are one of the most effective treatment modalities for attention deficit hyperactivity disorder (ADHD) and may cause various movement disorders. This review discusses various movement disorders related to stimulant use in the treatment of ADHD. We reviewed the current knowledge on various movement disorders that may be related to the therapeutic use of stimulants in patients with ADHD. Recent findings suggest that the use of stimulants and the onset/aggravation of tics are more likely to be coincidental. In rare cases, stimulants may cause stereotypies, chorea, and dyskinesia, in addition to tics. Some epidemiological studies have suggested that stimulants used for the treatment of ADHD may cause Parkinson’s disease (PD) after adulthood. However, there is still a lack of evidence that the use of stimulants in patients with ADHD may cause PD, and related studies are only in the early stages. As stimulants are one of the most commonly used medications in children and adolescents, close observations and studies are necessary to assess the effects of stimulants on various movement disorders, including tic disorders and Parkinson’s disease.
兴奋剂,如安非他命和哌醋甲酯,是治疗注意缺陷多动障碍(ADHD)最有效的方法之一,并可能导致各种运动障碍。这篇综述讨论了与多动症治疗中兴奋剂使用相关的各种运动障碍。我们回顾了目前关于各种运动障碍的知识,这些运动障碍可能与多动症患者使用兴奋剂治疗有关。最近的研究结果表明,兴奋剂的使用和抽搐的发作/加重更可能是巧合。在极少数情况下,兴奋剂除了抽搐外,还可能引起刻板印象、舞蹈病和运动障碍。一些流行病学研究表明,用于治疗多动症的兴奋剂可能会导致成年后的帕金森病(PD)。然而,目前仍缺乏证据表明ADHD患者使用兴奋剂可能导致PD,相关研究仅处于早期阶段。由于兴奋剂是儿童和青少年最常用的药物之一,因此有必要进行密切的观察和研究,以评估兴奋剂对各种运动障碍的影响,包括抽动障碍和帕金森病。
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引用次数: 3
Patterns of Restricted and Repetitive Behaviors in Toddlers and Young Children with Autism Spectrum Disorder 自闭症谱系障碍幼儿的限制性和重复性行为模式
IF 2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5765/jkacap.220001
Da-Yea Song, Dabin Kim, Hannah J. Lee, Guiyoung Bong, Jae Hyun Han, H. Yoo
Objectives Restricted and repetitive behaviors (RRBs) are a core symptom in the diagnosis of autism spectrum disorder (ASD). The complexity of behavioral patterns has called for the creation of phenotypically homogeneous subgroups among individuals with ASD. The purpose of this study was 1) to investigate the different types of RRBs and 2) to explore whether subgroups created by RRBs would show unique levels of functioning in toddlers and young children with ASD. Methods A total of 313 children with ASD, aged 12–42 months were included in the analysis. The Autism Diagnostic Interview-Revised was used to obtain information on the different types of RRBs by grouping 15 items into six categories. The Vineland Adaptive Behaviors Scale, a parent-reported questionnaire, was used to measure adaptive functioning. A portion of the children were analyzed separately for verbal-related RRBs based on their expressive language level. Two-step cluster analysis using RRB groups as features was used to create subgroups. Analysis of covariance while covarying for age and language was performed to explore the clinical characteristics of each cluster group. Results Sensory-related RRBs were the most prevalent, followed by circumscribed interests, interest in objects, resistance to change, and repetitive body movements. A subset of the children was analyzed separately to explore verbal-related RRBs. Four cluster groups were created based on reported RRBs, with multiple RRBs demonstrating significant delays in adaptive functioning. Conclusion Heterogeneity of RRBs emerges at a young age. The different patterns of RRBs can be used as valuable information to determine developmental trajectories with better implications for treatment approaches.
目的限制和重复行为(RRBs)是自闭症谱系障碍(ASD)诊断的核心症状。行为模式的复杂性要求在ASD患者中建立表型同质的亚群。本研究的目的是1)调查不同类型的RRBs, 2)探索由RRBs产生的亚组是否会在幼儿和ASD幼儿中表现出独特的功能水平。方法对313例年龄12 ~ 42月龄的ASD患儿进行分析。《自闭症诊断访谈-修订版》通过将15个项目分为6类来获取不同类型RRBs的信息。Vineland适应行为量表是一份家长报告的问卷,用于测量适应功能。根据部分儿童的语言表达水平,对他们的语言相关RRBs进行单独分析。采用两步聚类分析,以RRB组为特征创建子组。对年龄和语言进行协方差分析,探讨每组患者的临床特征。结果感官相关的RRBs最为普遍,其次是限制性兴趣、对物体的兴趣、抗拒改变和重复的身体动作。对一部分儿童进行单独分析,以探索与语言相关的rrb。根据报告的RRBs创建了四个集群组,其中多个RRBs表现出显著的适应性功能延迟。结论RRBs在年轻时出现异质性。RRBs的不同模式可以作为有价值的信息来确定发育轨迹,从而更好地指导治疗方法。
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引用次数: 1
How Must We Prepare in the Next Decades When Caring for Those With Developmental Disabilities: “Grown Up” (2018) 如何在未来几十年为照顾发育性残疾人士做好准备:《长大成人》(2018)
IF 2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5765/jkacap.220007
Jun-Won Hwang
The Guarantee of Rights and Support for Persons with Developmental Disabilities Act was enacted and revised in 2014. However, national measures for persons with developmental disabilities remain insufficient. In the film, “Grown Up,” director Hyeyoung Jang filmed the daily life of her sister, who has developmental disabilities. She raised not only the issue of institutionalization in people with developmental disabilities in Korea but also the issue of a lack of policies that would be essential to them and their family members. In the future, I hope that as experts, child and adolescent psychiatrists in Korea will pay more attention to the lives of people with developmental disabilities outside the clinic and propose policies to help them and their family members.
2014年颁布并修订了《发育障碍者权利保障法》。然而,针对发育性残疾者的国家措施仍然不足。在电影《长大了》中,导演张惠英拍摄了患有发育障碍的妹妹的日常生活。她不仅提出了韩国发育障碍者的收容问题,还提出了对他们及其家庭成员至关重要的政策缺乏的问题。未来,我希望作为专家,韩国的儿童和青少年精神科医生能够更多地关注诊所之外的发展障碍患者的生活,并提出帮助他们及其家人的政策。
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引用次数: 0
Concept of Synchronized Individuation Based on the Characters in a Movie and a Fairy Tale 基于电影和童话人物的同步个性化概念
IF 2 Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5765/jkacap.220004
D. Moon, G. Bahn
Objectives Among adolescent development tasks, being independent of parents is an essential process for emotional and physical separation. There are many conflicts of separation and individuation between parents and adolescents; however, most clinicians explore the process of separation and individuation only from adolescents’ perspective. Whether simultaneously or sequentially, separation-individuation occurs between adolescents and parents, respectively. The authors have already introduced the theory of synchronized individuation in a clinical case to explain the concept of this intersubjective phenomena. This study also attempts to prove the synchronized individuation theory through the interaction of characters in a movie and a fairy tale. Methods The authors present the basis for the theory of synchronized individuation of adolescence through the growing process of Mason Junior, the main character of the movie “Boyhood,” and from the process of the separation of a hen, Sprout, and an orphaned duckling in “The hen who dreamed she could fly.” Results Synchronized individuation was developed and observed from Mason, the son’s perspective in “Boyhood,” and Sprout, the mother’s subjective perspective in the story of the hen. Conclusion Increasing conflict and mutual impact in the relationship between adolescents and parents, ambivalent feelings for separation, selective identification of each other, mutual respect through mutual recognition, and role changes in relationship position were confirmed. Sons and mothers were individualized with synchronization.
在青少年发展任务中,脱离父母是情感和身体分离的重要过程。父母与青少年之间存在着许多分离和个性化的冲突;然而,大多数临床医生只从青少年的角度来探讨分离和个性化的过程。无论是同时发生还是先后发生,分离-个性化分别发生在青少年和父母之间。作者已经在一个临床案例中引入了同步个体化理论来解释这种主体间现象的概念。本研究还试图通过电影和童话人物的互动来证明同步个性化理论。方法通过电影《少年时代》中主人公小梅森的成长过程,以及电影《梦想飞翔的母鸡》中一只名叫斯普劳特的母鸡和一只失去双亲的小鸭子的分离过程,为青少年同步个性化理论提供依据。结果同步个性化从《少年时代》中儿子的视角梅森和母鸡故事中母亲的主观视角斯普劳特得到了发展和观察。结论青少年与父母关系中冲突和相互影响的增加、分离感的矛盾、对彼此的选择性认同、通过相互承认而产生的相互尊重、以及关系位置的角色变化均得到了证实。儿子和母亲的个体化与同步。
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引用次数: 0
Finding Common Interests. 寻找共同兴趣。
IF 2 Q2 Medicine Pub Date : 2022-01-01 DOI: 10.5765/jkacap.210035
Hee Jeong Yoo
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引用次数: 0
Preliminary Report of Validity for the Infant Comprehensive Evaluation for Neurodevelopmental Delay, a Newly Developed Inventory for Children Aged 12 to 71 Months. 新编制的12 ~ 71月龄婴幼儿神经发育迟缓综合评价量表效度初步报告
IF 2 Q2 Medicine Pub Date : 2022-01-01 DOI: 10.5765/jkacap.210033
Minha Hong, Kyung-Sook Lee, Jin-Ah Park, Ji-Yeon Kang, Yong Woo Shin, Young Il Cho, Duk-Soo Moon, Seongwoo Cho, Ram Hwangbo, Seung Yup Lee, Geon Ho Bahn

Objectives: Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study's objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12-71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool's validity and cut-off.

Methods: Multidisciplinary experts devised the "Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND)," an assessment method that comes in two versions depending on the age of the child: 12-36 months and 37-71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant- Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores.

Results: A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach's alpha was positive (0.533-0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5-0.7 and specificity 0.7-0.9.

Conclusion: The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12-36 months and 37-71 months.

目的:早期发现婴儿发育问题并进行必要的干预是很重要的。为了确定合并症,需要进行全面的评估。该研究的目标是:1)通过识别和引出与幼儿(12-71个月)发育迟缓相关的概念,生成量表项目;2)开发发育迟缓和合并症的综合筛查工具;3)评估工具的有效性和截止值。方法:多学科专家设计了“婴儿神经发育迟缓综合评估(ICEND)”,这是一种评估方法,根据儿童的年龄分为两个版本:12-36个月和37-71个月,通过每月研讨会和重点小组访谈。ICEND由风险因素、恢复力因素和临床量表三部分组成。在第一部分和第二部分中,有41名看护人回答了问卷。第3部分涉及临床医生评估10个子量表,分别使用98份和114份问卷对年轻人和老年人版本进行评估。采用儿童行为量表、优势与困难问卷、婴幼儿社会情绪评估量表和韩国婴幼儿发展筛选测验对ICEND进行并发效度分析。对典型和高危婴儿进行分析,以确定并发效度、信度和截止分数。结果:共有296人参与研究,其中57人为高危人群(19.2%)。Cronbach’s alpha为正(0.533 ~ 0.928)。在大多数领域,ICEND表现出公平的区分能力,敏感性为0.5-0.7,特异性为0.7-0.9。结论:ICEND是可靠和有效的,表明其有潜力作为评估12-36个月和37-71个月儿童神经发育迟缓和合并症的辅助工具。
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引用次数: 1
期刊
Journal of the Korean Academy of Child and Adolescent Psychiatry
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